PB2290: IMPACT OF RESOURCE AVAILABILITY ON OUTCOMES OF DIFFUSE LARGE B-CELL LYMPHOMA IN PAKISTAN: A DEVELOPING COUNTRY EXPERIENCE
Authors: Raheel Iftikhar, Usman Ahmad, Humera Mahmood, Zeeshan Ahmed Khan, Ghulam Haider, Misbah Masood, Nida Anwar, Qamar Javed, Abbas Khokhar, Nadia Sajid, Shanzah Shahbaz, Munira Moosajee, Zeba Aziz
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse large B-cell lymphoma is the commonest non-Hodgkin lymphoma and offers diagnostic and management challenges in low middle income countries (LMICs) with limited resources. Owing to lack of national cancer care programs in most of LMICs, patients are managed in different resource environments depending on access, financial resources and available health care services. Aims: This study was conducted to determine the impact of resource availability on outcomes of diffuse large B-cell lymphoma (DLBCL) patients in Pakistan. Methods: This multicenter retrospective study included 652 patients from 13 public and private sector hematology oncology centers across Pakistan. Patients were divided into limited and enhanced resource settings as per national DLBCL guidelines (1) and included all patients more than 14 years of age with a histopathological diagnosis of DLBCL. Results: Median age at diagnosis was 47 years (range 14-89 years) with 79% of the patients less than 60 years at the time of diagnosis. Male to female ratio was 2.5:1. Majority of the patients; 452(69.3%) were treated in limited resource settings. IPI score was available for only 181 (27.7%) patients and immunohistochemical markers were applied on 430 (65.9%) samples. Demographic and clinical differences in patients treated in limited and enhanced resources are tabulated (table 1). Patients treated in limited resource settings were younger in age (p=.001), immunohistochemistry was not done (47.8%) or details were not available (28.5%) and CT scan was used for staging in majority of the patients (61.5%). Rituximab was not used as first line therapy in 37.5% of limited resource settings and this impacted overall response rate (53.5% CHOP versus 73.2% R-CHOP; p 0.00). End of treatment response details were available for 356 (54.6%) patients and CT scan was used for response assessment in 41% patients in limited resource setting. Survival status was not available for 305 (46.8%) patients at the time of data collection due to loss of follow-up and were censored at the time of data analysis. Both OS and DFS were better in enhanced resource settings (OS of 52% in enhanced and 35.4.% in limited resource settings, p=0.000 while DFS 46% as compared to 31.4% in limited resource settings; p=0.00 while DFS). Summary/Conclusion: In countries with limited resources, more efforts are required to reduce disparities in cancer care to improve survival outcomes. References 1.Iftikhar R, Mir MA, Moosajee M, Rashid K, Bokhari SW, Abbasi AN, et al. Diagnosis and Management of Diffuse Large B-Cell Lymphoma: Society of Medical Oncology, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology Joint Clinical Practice Guideline. 2021;7:1647-58.Keywords: Diffuse large B cell lymphoma, B cell lymphoma, Lymphoma, Non-Hodgkin’s lymphoma